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. 2017 Mar 31;30(1):35-38.

Lactate: prognostic biomarker in severely burned patients

A Mokline  1   2 , A Abdenneji  1   3 , I Rahmani  1   2 , L Gharsallah  1   2 , S Tlaili  1   2 , I Harzallah  4   5 , B Gasri  1   2 , R Hamouda  1   2 , A A Messadi  1   2
Affiliations

Lactate: prognostic biomarker in severely burned patients

A Mokline et al. Ann Burns Fire Disasters. .

Abstract
in English, French

Plasma lactate (PL) has been used as a marker of cellular hypoxia and shock. The correlation between PL and clinical outcome has been well accepted in hemorrhagic and septic shock. In contrast to the existing evidence, there are no or almost no data dealing with lactate and burn-related outcome. We attempted to assess whether early plasma lactate (PL) is a useful parameter to predict outcome in burned patients. A prospective study was conducted in a 20-bed adult burn ICU at a university-affiliated teaching hospital in Tunis. Patients admitted within the first 24h post burn with greater than 10% total body surface area (TBSA) burned were enrolled in the study. There were 60 males and 20 females. Mean age was 40.7 ± 19.5 years old, and average TBSA was 32 ± 21%. At admission, 86.7% patients had an initial lactate value of more than 2 mmol/L. In our study, an initial lactate value of 4 mmol/L provided the best sensitivity and specificity: 88% and 79% respectively for predicting sepsis, with an area under the ROC curve of 0,82. Furthermore, plasma lactate cut-off value for mortality prediction was 4.46 mmol/l with a good sensitivity (86%) and specificity (92%). Mortality rate was 36.25%. Plasma lactate appears to be a powerful predictor biomarker of sepsis and mortality in burn patients.

Le lactate plasmatique (LP) est utilisé comme marqueur de choc et d’hypoxie cellulaire. La corrélation entre LP et pronostic est validée dans les chocs hémorragique et septique. Il n’y a que peu voire pas de données concernant PL et pronostic chez les brûlés. Nous avons étudié si la mesure précoce de PL avait une valeur pronostique chez les brûlés. Une étude prospective a ainsi été menée dans l’unité de réanimation pour adultes brûlés (20 lits) du CHU de Tunis. Les patients (60 hommes et 20 femmes) admis dans les 24 h d’une brûlure touchant plus de 10% de SCT ont été inclus. L’âge était de 40,5 +/- 19,5 ans, la surface brûlée de 32 +/- 21%. La grande majorité (86,7%) des patients avaient LP > 2 mmol/L à l’admission. Une valeur > 4 mmol/L étaient la plus prédictive de complication septique, avec une sensibilité de 88%, une spécificité de 9% et une aire sous la courbe ROC de 0,82. La mortalité était de 36,25% et un seuil de LP à 4,46 mmol/L prédisait le décès avec une sensibilité de 86% et une spécificité de 92%. LP semble donc être un marqueur prédictif fiable de sepsis et de mortalité chez les brûlés.

Keywords: lactate; mortality; prognostic biomarker; sepsis; severely burned.

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Figures

Table I
Table I. Correlation between lactate, TBSA and sepsis
Fig. 1
Fig. 1. ROC Curve of plasma lactate to predict sepsis
Table II
Table II. Initial lactate and organ failure
Table III
Table III. Multivariate analysis for organ failure for plasma lactate > 4 mmol/l
Table IV
Table IV. Multivariate analysis of factors predicting mortality
Fig. 2
Fig. 2. ROC Curve of plasma lactate in predicting mortality.
See this image and copyright information in PMC

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